| Dr Jonathan W Heusel, MD | |
| 4320 Forest Park Ave, Ste 209, Saint Louis, MO 63108-2979 | |
| (314) 362-5641 | |
| (314) 362-0369 | 
| Full Name | Dr Jonathan W Heusel | 
|---|---|
| Gender | Male | 
| Speciality | Pathology - Molecular Genetic Pathology | 
| Location | 4320 Forest Park Ave, Saint Louis, Missouri | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1255329058 | NPI | - | NPPES | 
| 1043414113 | Medicaid | MO | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207ZP0007X | Pathology - Molecular Genetic Pathology | 108616 (Missouri) | Primary | 
| Entity Name | Stony Brook Pathologists, University Faculty Practice Corporation | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1912944794 PECOS PAC ID: 2163502162 Enrollment ID: O20080103000301 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Dr Jonathan W Heusel, MD 660 S Euclid Ave, Cb 8118, Saint Louis, MO 63110-1010 Ph: (314) 362-5641 | Dr Jonathan W Heusel, MD 4320 Forest Park Ave, Ste 209, Saint Louis, MO 63108-2979 Ph: (314) 362-5641 | 
| Dr. Erin Elizabeth Ely, M.D. Pathology Medicare: Not Enrolled in Medicare Practice Location: 1300 Clark Ave, Saint Louis, MO 63103 Phone: 314-622-4971 Fax: 314-977-7615 | |
| Dr. Richard Justin Perrin, MD Pathology Medicare: Not Enrolled in Medicare Practice Location: 1 Barnes Jewish Hospital Plz, Div Pa Anatomic And Molecular Path, Saint Louis, MO 63110 Phone: 314-362-5641 Fax: 314-362-0369 | |
| Dr. Shouying Du, M.D Pathology Medicare: Accepting Medicare Assignments Practice Location: 6420 Clayton Rd, Saint Louis, MO 63117 Phone: 314-344-7525 Fax: 314-344-7226 | |
| Virgilio P Dumadag, MD Pathology Medicare: Not Enrolled in Medicare Practice Location: 3015 N Ballas Rd, Department Of Pathology, Saint Louis, MO 63131 Phone: 314-996-4285 Fax: 314-996-5551 | |
| Alexander D Babich, M.D. Pathology Medicare: Not Enrolled in Medicare Practice Location: 6420 Clayton Rd, Saint Louis, MO 63117 Phone: 314-768-8202 Fax: 314-768-7145 | |
| Mary A. Rudloff, M.D. Pathology Medicare: Not Enrolled in Medicare Practice Location: 11133 Dunn Rd, Dept. Of Pathology, Saint Louis, MO 63136 Phone: 314-653-5630 Fax: 314-653-4099 | |
| Dr. Beverly Kraemer, M.D. Pathology Medicare: Not Enrolled in Medicare Practice Location: 660 Office Pkwy, Saint Louis, MO 63141 Phone: 314-991-8015 Fax: 314-991-0691 |